Pelvic Sepsis After IPAA Adversely Affects Function of the Pouch and Quality of Life

Kiely, James M.; Fazio, Victor W.; Remzi, Feza H.; Shen, Bo; Kiran, Ravi P.

doi:10.1097/dcr.0b013e318246418e

Cited by 127 publications

(75 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the present study, ostomy was successfully closed except in two patients after hand‐sewn IPAA, and the patients in both groups achieved adequate anal function. A previous article reported worse functional outcomes after pelvic sepsis in patients who underwent IPAA 28. The low pouch‐related complication rate in the present study could have contributed to the excellent functional outcomes.…”

Section: Discussionsupporting

confidence: 53%

Postoperative complications after stapled and hand‐sewn ileal pouch‐anal anastomosis for familial adenomatous polyposis: A multicenter study

Konishi

Ishida

Ueno

et al. 2017

Annals of Gastroent Surgery

View full text Add to dashboard Cite

Ileal pouch‐anal anastomosis (IPAA) after total proctocolectomy (TPC) can be conducted with either hand‐sewn or stapled anastomosis for patients with familial adenomatous polyposis (FAP). Although stapled IPAA without mucosectomy has a higher risk for developing adenomas in the remnant mucosa, it is the simpler procedure with potential benefit in short‐term outcomes. However, it remains controversial as to whether stapled IPAA has any advantages in reducing postoperative complications. The aim of the present study was to compare the postoperative complications and short‐term outcomes of stapled and hand‐sewn IPAA for patients with FAP, using a multicenter cohort sample in Japan. Data of 143 patients with FAP who underwent TPC with stapled IPAA (n=37) and hand‐sewn IPAA (n=106) at 23 institutions between 2000 and 2012 were collected. Postoperative complications, proportion of ostomy, fecal continence and overall survival were compared. Overall rates of the Clavien‐Dindo grade II‐IV complications were not different between the two groups (19% in stapled vs 25% in hand‐sewn, P=.42), with significantly fewer pouch‐related complications including leakage, pelvic abscess, vaginal fistula and anastomotic stricture in stapled IPAA (none in stapled vs 11% in hand‐sewn, P=.036). There was no mortality. Proportion of ostomy at 12 months was similar (2.7% in stapled vs 4.3% in hand‐sewn, P=.26). Mean Wexner score was similar. (0.47 in stapled vs 2.0 in hand‐sewn, P=.12). Five‐year overall survival excluding Stage IV patients was 96% in both groups. Stapled IPAA is a safe option in patients with FAP with a potential benefit in reducing pouch‐related complications.

show abstract

Section: Discussionsupporting

confidence: 53%

Postoperative complications after stapled and hand‐sewn ileal pouch‐anal anastomosis for familial adenomatous polyposis: A multicenter study

Konishi

Ishida

Ueno

et al. 2017

Annals of Gastroent Surgery

View full text Add to dashboard Cite

show abstract

“…Indications for pouch salvage may influence outcome. Pelvic sepsis is the most dreaded complication of IPAA, 3,4 affecting 25% of patients to various extents 1,2,4 and being responsible for subsequent pouch excision in up to 40% of patients. 5 Failure rates for IPAA range between 3.5 and 15% overall.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

Pellino¹,

Selvaggi²

2015

ECCOJC

View full text Add to dashboard Cite

Background and Aims: Failure rates of restorative proctocolectomy with ileo pouch-anal anastomosis (IPAA) range between 3.5 and 15%. Salvage surgery aims to preserve the pouch and transanal evacuation. We report our experience with salvage, review the outcomes of revisional pouch surgery, and propose a classification of pouch dysfunction. Methods: We collected data on patients undergoing pouch salvage surgery between 1987 and 2014 at our hospital. Pre-and post-salvage functional data were assessed. Function at the 3-year follow-up was compared with that of matched IPAA controls (study patients:controls, 1:3). Results: Considering only patients who underwent primary IPAA at our centre (n = 31), 5-year failure was higher after salvage compared with primary IPAA (28.8 vs 5.7% log rank test, p = 0.005). Overall, we included 39 patients, with eight additional patients who received primary IPAA elsewhere, undergoing 46 procedures. Most patients had a J-pouch (74.4%) and needed salvage for septic complications. A transperineal approach was used in 22 patients, whereas 17 underwent abdominal salvage, with 77.3 and 64.7% success rates, respectively. Minor surgery was effective but required repeated procedures. Overall failure was 28.2% at a median follow-up of 42 (1-153) months. A significant decrease in bowel frequency (p = 0.021) and rate of urgency (p = 0.009) was observed at the 3-year follow-up after salvage in 25 patients available for comparison. Functional results after major salvage procedures were poorer compared with healthy IPAA controls (p = 0.003). Conclusions: Salvage surgery is effective and safe in experienced teams, but the 5-year failure rate is higher after salvage than after successful primary pouch surgery. Sepsis brings about a higher risk of failure compared with mechanical causes of dysfunction.

show abstract

“…Early pelvic sepsis [4,5] is mainly due to breakdown of the IPAA and may determine peri-pouch abscess formation. The clinical impact of pelvic sepsis can be reduced by a temporary stoma, which is mandatory in patients with risk factors for anastomotic complications [9].…”

mentioning

confidence: 99%

“…Early postoperative pelvic sepsis, which is responsible for significant functional disturbances [4] and impaired HRQoL in the long term [1][2][3][4][5][6], is the most dreaded complication of IPAA [4,5]. Up to 25 % of IPAA patients are affected to some degree [1][2][3][4][5][6][7] and are at greater risk of pouch-related fistula. The risk of pelvic sepsis is inversely proportional to the surgeon's experience with pouch surgery, suggesting that some factors responsible for pelvic sepsis and late formation of pouch-related fistulae are modifiable.…”

mentioning

confidence: 99%

“…Irrespective of age at surgery and disease duration [2,3], IPAA achieves optimal functional results, and this is reflected in health-related quality of life (HRQoL). Early postoperative pelvic sepsis, which is responsible for significant functional disturbances [4] and impaired HRQoL in the long term [1][2][3][4][5][6], is the most dreaded complication of IPAA [4,5]. Up to 25 % of IPAA patients are affected to some degree [1][2][3][4][5][6][7] and are at greater risk of pouch-related fistula.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Pouch-related fistula and intraoperative tricks to prevent it

Selvaggi

Pellino

2015

Tech Coloproctol

View full text Add to dashboard Cite

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is the mainstay of treatment for refractory ulcerative colitis (UC) or dysplasia in chronic UC. In spite of the advances in the medical treatment for UC, up to 30 % of patients may still require surgery [1]. Irrespective of age at surgery and disease duration [2,3], IPAA achieves optimal functional results, and this is reflected in health-related quality of life (HRQoL). Early postoperative pelvic sepsis, which is responsible for significant functional disturbances [4] and impaired HRQoL in the long term [1][2][3][4][5][6], is the most dreaded complication of IPAA [4,5]. Up to 25 % of IPAA patients are affected to some degree [1][2][3][4][5][6][7] and are at greater risk of pouch-related fistula. The risk of pelvic sepsis is inversely proportional to the surgeon's experience with pouch surgery, suggesting that some factors responsible for pelvic sepsis and late formation of pouch-related fistulae are modifiable.Pouch-related fistulae can develop at any time, but often occur some months after IPAA, and might be related to medical factors and unidentified Crohn's disease (CD) [7,8], but technical faults may be responsible for this complication in a relevant number of patients.Treatment for pouch-related fistulae is difficult. The article on this type of fistula, recently published by Gaertner et al. [8] in this journal, is of great interest. The authors describe the outcomes of the treatment for pouchrelated fistula after IPAA in a retrospective series from 1989 through 2011. Twenty-five patients presented with pouch-related fistula. Each patient underwent on average 2.8 (range 1-10) procedures or repairs, consisting of seton drainage (n = 20), fibrin glue injection (n = 11), fistulotomy (n = 5), collagen plug insertion (n = 4), transperineal repair (n = 3), ileal advancement flap (n = 2), insertion of cutting seton (n = 2), Martius flap (n = 1), transabdominal repair (n = 1), and revision of ileal pouch-anal anastomosis with gracilis muscle interposition (n = 1). In 24 % of patients, a temporary loop ileostomy was fashioned, whereas some CD patients received concomitant medical treatment. Complete healing was achieved in 64 % of patients with a stepwise diagnostic and therapeutic approach.The paper includes 60 % of patients with CD of the pouch, which was the only factor associated with persistent fistulas in this series [8]. The authors provide their algorithm for managing ileal-pouch-related fistulas based on their etiology (surgical complications, cryptoglandular, or CD).However, every effort should be made to reduce the incidence of surgical complications by acting on modifiable peri-and intraoperative factors.We have further subdivided fistula etiology specific to ileoanal pouches in Table 1.Early pelvic sepsis [4,5] is mainly due to breakdown of the IPAA and may determine peri-pouch abscess formation. The clinical impact of pelvic sepsis can be reduced by a temporary stoma, which is mandatory in patients with risk factors for anastomotic c...

show abstract

Pelvic Sepsis After IPAA Adversely Affects Function of the Pouch and Quality of Life

Abstract: Pelvic sepsis after IPAA leads to worse functional outcomes and quality of life even when it does not lead to pouch failure. This finding argues for careful attention to preoperative and intraoperative planning and strategies aimed at reducing this complication after IPAA.

Cited by 127 publications

References 13 publications

Postoperative complications after stapled and hand‐sewn ileal pouch‐anal anastomosis for familial adenomatous polyposis: A multicenter study

Postoperative complications after stapled and hand‐sewn ileal pouch‐anal anastomosis for familial adenomatous polyposis: A multicenter study

Outcomes of Salvage Surgery for Ileal Pouch Complications and Dysfunctions. The Experience of a Referral Centre and Review of Literature

Pouch-related fistula and intraoperative tricks to prevent it

Contact Info

Product

Resources

About